This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypoxic ischemic encephalopathy HIE is the brain manifestation of systemic asphyxia. Systemic asphyxia occurs in about 3 out of 1,000 full-term infants and in nearly 60% of very low birth weight premature newborns. Between 20-50% of asphyxiated babies who exhibit HIE die during the newborn period. Of the survivors, up to 25% have permanent neuropsychologic handicaps in the form of cerebral palsy, with or without associated mental retardation, learning disabilities, or epilepsy. Systemic asphyxia, with the end consequences being HIE, has many different etiologies. Systemic asphyxia may occur prior to delivery placental abruption, toxemia, maternal collagen vascular disease, during delivery prolonged labor, difficult delivery, abnormal presentation or after delivery sepsis, infectious disease, respiratory distress. Currently, there is no reliable laboratory test to assess the degree of neuronal injury. This study in neonates suffering HIE is designed to collect preliminary data characterizing the association between the concentrations of selected blood and urine biomarkers and the physical exam and neuroimaging findings of these neonates. Identification of biomarkers of brain injury in neonates will have several important future clinical applications: 1. to stratify patients by the severity of their HIE;2. to better monitor the progression of brain injury-induced pathology and recovery;3. to monitor the effects of therapy/intervention;and 4. to predict outcome more accurately after HIE.